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Patient Education and Counseling 99 (2016) 13331342

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Patient Education and Counseling


journal homepage: www.elsevier.com/locate/pateducou

I see how you feel: Recipients obtain additional information from


speakers gestures about pain
Samantha J. Rowbothama,b,c,* , Judith Hollerd , Alison Weardena , Donna M. Lloyde
a
School of Psychological Sciences, University of Manchester, Manchester, UK
b
Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, Australia
c
The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia
d
Max Planck Institute for Psycholinguistics, Nijmegen, Netherlands
e
School of Psychology, University of Leeds, Leeds, UK

A R T I C L E I N F O A B S T R A C T

Article history: Objective: Despite the need for effective pain communication, pain is difcult to verbalise. Co-speech
Received 9 November 2015 gestures frequently add information about pain that is not contained in the accompanying speech. We
Received in revised form 7 March 2016 explored whether recipients can obtain additional information from gestures about the pain that is being
Accepted 13 March 2016
described.
Methods: Participants (n = 135) viewed clips of pain descriptions under one of four conditions: 1) Speech
Keywords: Only; 2) Speech and Gesture; 3) Speech, Gesture and Face; and 4) Speech, Gesture and Face plus
Co-speech gesture
Instruction (short presentation explaining the pain information that gestures can depict). Participants
Nonverbal communication
Pain communication
provided free-text descriptions of the pain that had been described. Responses were scored for the
amount of information obtained from the original clips.
Findings: Participants in the Instruction condition obtained the most information, while those in the
Speech Only condition obtained the least (all comparisons p < 0.001).
Conclusions: Gestures produced during pain descriptions provide additional information about pain that
recipients are able to pick up without detriment to their uptake of spoken information.
Practice implications: Healthcare professionals may benet from instruction in gestures to enhance
uptake of information about patients pain experiences.
2016 Elsevier Ireland Ltd. All rights reserved.

1. Introduction 1.1. Pain communication

Recent research has revealed that when describing pain, co- Pain is a frequent feature of medical consultations and
speech gestures (spontaneous movements of the hands, arms and healthcare professionals need to understand the presence and
other body parts that are closely synchronised with speech [15]) nature of pain to provide appropriate management and support.
contain additional information over and above that contained in However, pain is a private, internal experience, directly accessible
speech [68], potentially making an important contribution to the only to the sufferer, making it vital that sufferers communicate their
communication of this experience. In the present study we use pain effectively to others. Despite this, pain is notoriously difcult
experimental methods to explore whether recipients are able to to verbalise in a way that truly captures the experience [914].
pick up the additional information from the gestures that Even when we nd the words to describe pain, these may have
accompany another persons pain description. different meanings to different people and even to the same person
across time, leading to potential miscommunication (see [15] for a
more detailed discussion of these issues).
The problems of verbal pain communication have led
researchers to consider additional channels through which
sufferers may communicate their pain experience to others. These
* Corresponding author at: Charles Perkins Centre, University of Sydney, NSW include facial expression [1618], rating scales and questionnaires
2006, Australia. [19,20], and drawings and photographs [9,10,2123]. More
E-mail addresses: samantha.rowbotham@sydney.edu.au (S.J. Rowbotham),
recently, research has considered the role of co-speech gestures
Judith.Holler@mpi.nl (J. Holler), alison.wearden@manchester.ac.uk (A. Wearden),
D.M.Lloyd@leeds.ac.uk (D.M. Lloyd).
as a means of sharing the private pain experience with others.

http://dx.doi.org/10.1016/j.pec.2016.03.007
0738-3991/ 2016 Elsevier Ireland Ltd. All rights reserved.
1334 S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342

1.2. Gestures and pain communication used experimental methods adapted from basic gesture research.
First we examined whether recipients are able to glean the
The gestures that are the focus of this article are those which additional information contained in the gestures that accompany
represent (or depict) semantic information directly related to the spoken pain descriptions, and, second, whether brief instruction
topic of speech (known as representational [24], or topic gestures about gestures leads to further increases in the information
[25,26]). For example, a gesture in which a circular movement is obtained.
made while saying she ran all the way around the block is related
to the topic of speech and depicts the path that the runner has 2. Method
taken. It has been well established through basic gesture research
that such gestures not only contain semantic information related 2.1. Participants
to the verbal message, but often add a substantial amount of
information that is not contained in the accompanying speech Participants (N = 135) were University staff and students. All
[5,2729], and that recipients glean meaningful information from were female, native English speakers and had normal or
gestures over and above that obtained from speech (see [30] for a corrected to normal vision, and none suffered from any language
meta-analysis). Taken together this indicates that gestures make an or hearing impairments. The mean age was 20 years (SD = 4
important contribution to communication, providing recipients years; Range = 1853 years), and 84% were right handed.1 The
with a more complete message than would be obtained from study was granted approval by the University Research Ethics
speech alone. Moreover, instructing participants to attend to Committee and all participants provided written informed
gestures while watching videos of children explaining solutions to consent prior to participation.
math problems increased the accuracy and amount of information
obtained about the strategies used to solve the problems [31]. This 2.2. Design
provides preliminary evidence that it is possible to increase the
uptake of information from gestures through instruction, with A between-participants design was used in which participants
specic instruction about the types of information that gestures were randomly allocated to one of four clip presentation
can convey providing the most benet [31]. conditions:
Despite this ability of gestures to communicate semantic
content related to the topic of speech, within the clinical 1) Speech Only (SO; video stilled with gesture and facial
communication literature gestures have typically been grouped information obscured) (n = 33).
with nonverbal behaviours (e.g. posture, gaze, facial expression 2) Speech and Gesture (SG; facial information obscured) (n = 34).
and touch) involved in relational and emotional expression (e.g. 3) Speech, Gesture, and Face (SGF) (n = 34).
communicating feelings, desires, personality, and attitudes 4) Speech, Gesture, and Face plus Instruction (SGF-Instruction)
) [3234]. Such a view overlooks the semiotic contribution of (n = 33).
gestures, and the present study is part of a growing body of work
which recognises the value of gestures in conveying detailed The SG condition was included to control for the possibility that
information within a clinical context [3539]. differences between the SO and SGF conditions may be due to
Recent research exploring the role of gestures in pain presence of facial (rather than gestural) information. The depen-
communication has revealed that gestures are frequently used dent variable was the amount of information contained in
to depict information about pain, including sensation, location, participants responses that was directly traceable to the gestures
size, and cause [68,37,39]. Heath [37] reported that when contained in the clips (see Analysis section for more information).
describing a tension headache, one patient said, its like a band,
while using a gesture to depict the feeling of a band tightening 2.3. Stimulus development
around the head. Gestures contribute a substantial amount of
information about pain that is not contained in the accompanying Video clips were created from interviews with 21 female
speech [68], for example using the words, quite sharp, it felt participants (21 right handed; M age = 23 years; SD = 8 years) who
quite sharp, while producing a gesture in which the ngers of both took part in a previous study in which they were lmed while
hands tensed and squeezed inwards towards the palms in a single describing a recently experienced physical pain [40]. The types of
slow clenching motion [8]. Here, the gesture contains additional pain included back/neck/shoulder pain, headache, stomach pain,
information about the nature of the sensation (i.e. that it was and leg/hip/foot pain, and there was a mixture of chronic and acute
clenching or squeezing) that was not contained in the speech. pain with pain durations ranging from less than 1 month to over
Taken together, this research demonstrates that co-speech 10 years.
gestures contain information about the subjective, perceptual To establish whether recipients could glean additional informa-
experience of pain. Given the difculties inherent in the verbal tion from gestures, it was necessary to produce clips in which
communication of pain, the information contained in gestures may gesture(s) added pain information that was not contained in
contribute to a fuller understanding of the pain experience. speech. Thus, for the 21 videos, we rst identied all representa-
Preliminary evidence that recipients pick up the information tional gestures (i.e. those containing semantic information) that
contained in speakers gestures during pain communication comes occurred during participants pain descriptions. We then used a
from Heath [37] who provides an example and qualitative analysis of a redundancy analysis [7,27,41,42], which involves considering the
GP repeating a patients gesture back to her to establish understanding information contained in each gesture with respect to the
in a consultation. However, experimental, quantitative studies of information contained in the accompanying speech and assessing
whether recipients benet from the information contained in the
gestures that accompany pain descriptions do not exist.
1
1.3. The present study Comparisons revealed no signicant differences in the amount of information
obtained by left and right-handed participants in any of the conditions (all p > .05),
and one-way ANOVAs conducted separately for left and right-handed participants
As the rst study to explore whether gestures can contribute to revealed the same pattern of results for both groups. Therefore, the data for both left
recipients understanding of another persons pain experience, we and right-handed participants is reported together.
S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342 1335

Fig. 1. Clip in which the speaker produces a gesture containing information about the location of the pain (lower back) that is not contained in the accompanying speech (it
just aches its a dull ache all the time across my back).

whether the gesture contributes any additional information that is gestures are, how they interact with speech, and the types of pain
not contained in the speech (i.e., is non-redundant with respect to information they may contain (including location, sensation, and
speech; see Fig. 1 for an example; see Reliability section for cause). Example clips of gestures (performed by an actor, none of
reliability procedures). This analysis yielded 48 clips in which the which matched the gestures in the experimental stimuli) were
gesture(s) contained additional information about pain. We included to illustrate this information. Narration was recorded
randomly selected one clip from each speaker, yielding 21 clips directly onto the presentation so that all participants heard the
(Mean length = 7.48 s; Range = 217 s). One clip was randomly same information. The presentation lasted for 5 min 28 s and
selected to be used in the practice trial of the experiment, while ended with an instruction to attend to gestures as well as speech
the other 20 appeared in the experiment proper. when viewing the clips in the main experiment (see Appendices A
The video clips were edited so that they were in the condition- and B).
specic presentation format. Blurring of the facial area (for the SO
and SG conditions) was performed using Gaussian and Fast Blur 2.6. Procedure
settings in Adobe1 Premier Pro1 [43]. Blurring was applied to the
whole of the facial area, including a sufcient amount of the Participants took part one at a time in a quiet testing cubicle.
surrounding area to account for movements of the head (see The study instructions were displayed on screen and participants
Fig. 1).2 For the Speech Only condition the video clips were freeze- completed a practice trial to familiarise themselves with the
framed while the hands were in a rest position (e.g., on the lap) so program and were given the opportunity to ask questions.
that no gestural information was available. In the SGF and Participants then began the experiment proper in which they
SGF-Instruction conditions, the video clips were presented in viewed the remaining 20 clips (order of presentation randomised).
their original format with both gestures and facial expressions Following each clip, participants were required to provide a free-
visible. text description of the pain that had been described. Participants
were encouraged to provide as much detail as possible and a list of
2.4. Stimulus presentation types of information to consider (e.g., pain location, sensation,
cause, duration, intensity) was provided on the screen. A break was
A computer program was used to present the video clips. Each included after every four clips and participants could choose to
clip was preceded by a xation cross in the centre of the screen begin again when they were ready. In the Instruction condition,
(displayed for 1 s) and immediately followed by a screen participants viewed the presentation before beginning the
containing a free-text description eld. There was no restriction experiment, but all other procedural details remained the same.
on the length of description that could be provided. Clips were
presented on a 17 Dell Monitor placed on a computer desk 2.7. Analysis
approximately 50 cm in front of the participant. Sound was played
through Sennheiser HD201 closed-cup headphones. 2.7.1. Identication of spoken and gestural information in clips
The analysis was primarily concerned with whether partic-
2.5. Instruction video ipants were able to pick up the additional information contained in
gestures, using an adapted form of the traceable additions
For the SGF-Instruction condition, a presentation was prepared analysis developed by Kelly and Church [45,46]. We prepared a
using PowerPoint1 [44] and consisted of a brief overview of what coding manual that could be used to score the information in
participants free-text descriptions against the information in the
original clip. For each clip, we created lists of the information
2
None of the gestures produced within the stimulus clips passed through this contained in speech and gestures, and compared these lists to
blurred area and therefore no gestures were obscured.
1336 S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342

Table 1
Thirteen categories of information about pain that were identied from speech and gestures.

Category Denition
Sensation What the pain feels like (e.g. throbbing, stinging, shooting)
Location Where the pain is located (e.g. arm, upper back)
Duration How long the pain lasts (e.g. persistent, short-lived)
Frequency How often the pain occurs (e.g. occasionally, everyday)
Intensity How strong the pain is (e.g. really strong pain, mild pain)
Onset How the pain comes on (e.g. suddenly, gradually)
Appearance Any physical signs of pain (e.g. bruising)
Movement Whether the pain moves around (e.g. moves up the neck, across the stomach)
Area/Size How large the pain is (e.g. whole head, small area of stomach)
Effects Physical or emotional effects of pain (e.g. difcultly engaging in activity, worrying)
Cause What caused/causes the pain (e.g. lifting something, accident)
Progression Changes in the pain over time (e.g. it started off throbbing then just ached)
Type What kind of pain it is (e.g. headache, backache)

Fig. 2. Clip in which the speaker produces a gesture containing information about the sensation of pain (cramping/squeezing/tightening) that is not contained in the
accompanying speech (itll usually come on quite suddenly).

allow the identication of any additions that were traceable to (SD = 1.19) items of information coded as traceable to gestures and
gestures (i.e., information contained in gestures that was not 4.26 (SD = 1.39) items of information traceable to speech per clip.
contained in the speech). The analysis of the original video clips
revealed that thirteen dimensions of pain were depicted within the 2.7.2. Scoring of participant responses
speech and/or gestures (see Table 1). The coding manual was used to score participants free-text
Fig. 2 displays a clip in which the participant says itll usually responses according to how much information was traceable to
come on quite suddenly while performing a gesture in which she speech and how much was traceable to gestures (i.e. contained
clenches the hands, suggesting a squeezing or cramping sensation. uniquely in gesture; see Table 2 for an example of how a participant
Here, the information traceable to speech was identied as Onset response to the clip presented in Fig. 2 was scored using this
(sudden), while the additional information traceable to gesture system). In order to be scored as containing information traceable
(i.e. that was only contained in gestures) was Sensation (cramping/ to speech or gestures, the information in the response had to match
squeezing/tight). the information identied within the original clip. For example, if a
The category of traceable to gesture concerned only the participant viewing the clip presented in Fig. 2 identied the
information gestures added over and above the information sensation of pain as tingling, this would not be scored as traceable
contained in the accompanying speech. On average there were 3.74 to gesture or speech as there is no indication in either modality
that the sensation is of this nature.

Table 2
Example scoring of participant response: sudden onset but also tightening or
2.7.3. Reliability
spasms that might indicate that the pain feels like a spasm or twinge. All data analysis was performed by SR. To ensure reliability
second coding was performed on 2025% of data at each stage of
Score Details
the analysis by an independent analyst blind to the study aims.
Traceable to speech 1 Sudden onset Agreement scores are presented in Table 3. High levels of
Traceable to gesture 1 Tightening/spasm/twinge
agreement were obtained at each stage of analysis [47].
Note: This was a participants description of the pain description presented in Fig. 2.
S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342 1337

Table 3
Agreement scores between original (SR) and second coder at each stage of analysis.

Analysis Second coder Agreement


Identication of representational gesture SH k = .84 (93%)
Identication of non-redundant gestures SH k = .84 (93%)
Identication of pain information in speech and gesture MN Speech: 81%
Gesture: 80%
Scoring participant responses MN Traceable to speech: k = .83 (93%)
Traceable to gestures: k = .72 (93%)

Note: SH is experienced in gesture analysis while MN is experienced in qualitative analysis.

Post hoc comparisons indicated that participants in the


Table 4
Means (and standard deviations) for amount of information obtained (traceable to conditions where gestures were visible (SG, SGF and
speech and gesture) per clip across the four presentation conditions. SGF-Instruction) obtained signicantly more information than
those in the SO condition, with this additional information directly
SO SG SGF SGF-Instruction
traceable to gestures (SG: p < .001, d = 2.79; SGF: p < .001, d = 2.32;
Traceable to speech 2.70 (0.33) 2.58 (0.41) 2.66 (0.40) 2.57 (0.34)
SGF-Instruction: p < 0.001, d = 4.00). There was no difference in the
Traceable to gesture 0.10 (0.10) 0.49 (0.18) 0.46 (0.21) 0.86 (0.28)
scores of participants who saw speech and gestures in the presence
(SGF) or absence (SG) of facial information (p = .921, d = 0.15).
Participants who received instruction in attending to and
interpreting gestures prior to viewing the video clips
(SGF-Instruction) obtained signicantly more information trace-
2.7.4. Statistical analysis
able to gestures than those who saw gestures but had not received
For each participant, the scores for information traceable to
this instruction (SG: p < 0.001, d = 1.61; SGF: p < .001, d = 1.63).
speech and traceable to gestures for each clip were averaged
There were no signicant differences between the conditions in
across the 20 video clips to give two overall scores per participant
terms of the amount of information directly traceable to speech,
(one for information obtained from speech, and one for informa-
[F(3, 130) = 0.90, p = 0.444, np2 = 0.02].
tion obtained from gesture). One-way ANOVAs were used to
Of the thirteen categories of information contained in the
compare the scores for amount of information obtained from
original clips (see Table 1), gestures contained additional informa-
gestures and speech across the four conditions (SO, SG, SGF, and
tion (i.e., information traceable to gestures) about ve aspects:
SGF-Instruction). Tukey HSD post-hoc comparisons were per-
Location, Sensation, Movement, Size, and Cause. Concerning the
formed, and an alpha criterion level of <0.05 (two-tailed) was
type of information that participants were able to obtain from
employed throughout. Data analysis was performed in SPSS v.20
gestures, the data in Fig. 3 indicate that participants were able to
[48].
glean at least some information about all ve categories from
gestures. Statistical analysis was not conducted on these data due
3. Results
to the amount of missing data (as not all clips contained
information about all ve aspects of the pain). However, the data
The main analysis focused on participants scores for informa-
show that participants were most procient at gleaning informa-
tion traceable to gestures and revealed a signicant difference
tion from gestures about pain location, and least procient for
between the conditions, [F(3, 68) = 100.48, p < 0.001, np2 = 0.64]
information about movement and size of the area affected by the
(see Table 4 for descriptive statistics).

50

45 SG
40 SGF
% of information obtained

SGF-Training
35

30

25

20

15

10

0
Location Sensation Movement Size Cause
Fig. 3. Percentage of information about each aspect of pain contained in gestures in original video clip that participants were able to glean from gestures across the three
gesture conditions (SG, SGF, and SGF-Instruction).
1338 S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342

pain. Concerning the impact of instruction, there were increases in of these ndings within the context of face-to-face clinical
the amount of information obtained following instruction for all interaction.
but one category (cause). The generalizability of the ndings is further limited by the fact
that the participants viewing the clips were university staff and
4. Discussion and conclusion students rather than health professionals. While subsequent pilot
work with medical students has suggested that this population is
4.1. Discussion not knowledgeable about the role of gestures in pain communica-
tion beyond indicating pain location and therefore may benet
Participants obtained a signicant amount of information about from instruction in gestures to improve information uptake, more
pain from speakers gestures, and receiving brief instruction about work is needed to determine the benecial effect of gestures for
gestures led to increases in the amount of information obtained. healthcare professionals interacting with patients. A further
There were no differences across conditions in the amount of limitation to the generalisability of the ndings is the use of an
information obtained from speech, indicating that recipients all-female sample and a relatively narrow age range. It is well
benet from gestures without detriment to the uptake of spoken established that males and females differ in their perception
information. Finally, the benecial effect of gestures was indepen- [6366] and communication [60] of pain, and an all-female sample
dent of any effect of seeing the speakers face and was therefore (both for the video clips and the participants in this study) was
directly attributable to the gestural movements. used to control for these differences. However, more work is
While a growing body of research suggests that speakers needed to understand the possible variations in gesture usage and
produce gestures depicting various dimensions of the physical pain uptake during pain communication by males and females, and by
experience (e.g., location, sensation, cause) [68,35,3739], this is different age groups (who, for example, may differ in pain
the rst to experimentally demonstrate that recipients can use this tolerance and stoicism). While the present study represents an
information to aid their understanding of pain. Healthcare important rst step in demonstrating the potential value of
professionals may benet from brief instruction about the role gestures in communicating information about the private,
of gestures in pain communication, and an important next step will subjective experience of pain, future work is needed to replicate
be to establish whether the additional information contributed by these ndings within a more representative sample during real
gestures has any demonstrable impact on clinical or patient clinical interactions.
outcomes, diagnostic accuracy, and empathy towards patients. In Within this rst attempt to explore recipients uptake of
addition to increasing information uptake, instruction to attend to gestural information about pain, we were primarily concerned
gestures may increase overall attention towards the pain sufferer, with whether recipients were able to glean the additional
positively inuencing patient satisfaction [49,50] and perceptions information from gestures that was not contained in the
of recipient involvement in the interaction [5153]. accompanying speech. However, it is well established that as well
These ndings may also have implications for healthcare as adding information, gestures often duplicate the content of
interactions more generally. Recent studies have highlighted the speech, potentially emphasising and reinforcing the spoken
role of gestures in a range of healthcare encounters, particularly information, increasing clarity, and aiding recollection. Thus,
when clinicians and patients do not share a common language gestures may benet recipients beyond the addition of extra
[35,38], and gestures may also play a role in the communication of information about pain, with the duplicated information in
non-pain-related symptoms. Our study strengthens the argument gestures also making a contribution to recipient uptake and
for attending to gestures in health-related encounters indicating understanding. While an analysis of the contribution of gestures
that not only are gestures produced in such contexts, but they can that duplicate spoken information was beyond the scope of the
be utilised by recipients to obtain more information about present study, this represents an important avenue for further
speakers experiences. Moreover, the benet of instructing people investigation.
to attend to gestures within an experimental setting with minimal The present study used a brief presentation to provide
distractions highlights the potential importance of explicitly information to participants about gestures. This format could be
encouraging recipients to attend to gestures during clinical easily integrated into communication skills training for healthcare
interactions where there may be other factors competing for their professionals, either as part of online or didactic teaching. While
attention. Research indicates that clinicians spend considerable the results indicate that such instruction is benecial for increasing
portions of the consultation looking at computerised medical the uptake of gestural information, it is not clear whether this is
records [5458] and thus may miss out on information contributed due to specic knowledge gained about gestures or simply from
by gestures. raised awareness of this modality as a result of being instructed to
The use of short video clips is common in gesture comprehen- attend to gestures. However, Kelly and colleagues [31] showed that
sion research [31,45,46,5961] as it allows for ne-grained increasingly explicit instruction (no instruction, hint, general
analysis, demonstrating that the effect of gestures is directly instruction about gestures, and specic instruction about task-
attributable to the information they contain, rather than, for relevant gestures) resulted in incremental gains in accuracy,
example, participants just guessing more information when suggesting that the benet of instruction is not simply related to
gestures are present. However, these are not representative of raising awareness. Finally, a key question for future work is
the longer, more complete pain descriptions that occur within whether such brief instruction about gestures gives rise to a lasting
clinical interactions, limiting the applicability of the ndings. effect or whether intermittent refreshers are needed to give rise to
Further, the lack of interactional demands and social constraints on a sustained effect on the uptake of gestural information.
gaze when viewing clips may allow recipients to devote more
attention to gestural information within this study than would be 4.2. Conclusion
possible in face-to-face interaction. Holler and colleagues [62]
found that participants in a face-to-face condition were equally The present study demonstrates that recipients are not only
effective at gleaning information from the speakers gestures as able to benet from the rich, visual information about pain
those in a video condition, providing some support for the contained in speakers gestures, but also that their ability to glean
applicability of these ndings to face-to-face communication. this information is enhanced through brief instruction. These
However, further work is needed to demonstrate the applicability ndings add weight to the idea that we should be looking as well as
S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342 1339

listening to those in pain in order to ensure that pain Acknowledgements


communication is as successful as possible. While follow-up work
is needed to establish the validity of these ndings within clinical Samantha Rowbotham completed this work as part of her PhD
contexts, this study provides a strong starting point for such which was funded by the School of Psychological Sciences,
investigations. University of Manchester, UK. Judith Holler was supported by
ERC Advanced Grant #269484-INTERACT awarded to Prof. S.C.
4.3. Practice implications Levinson during parts of this project. The authors would like
extend their gratitude to the participants who took part in this
Providing brief instruction to healthcare professionals about research and to Dr Melissa Noke and Dr Stacey Humphries for
the role of gestures in pain communication may increase uptake of second coding of the data for reliability purposes. Finally we would
information about the pain experience, providing a clearer picture like to thank Mr Yu Li for creating the computer program used in
of a sufferers pain and potentially reducing the risk of the experiment and Ms Jodie Connor for performing the gestures
misinterpretation. Highlighting the role of gestures within clinical used in the Instruction presentation.
communication training may prove benecial for improving
healthcare professionals ability to glean additional information Appendix A.
from this modality during pain communication.

Presentation slides for gesture instruction condition


1340 S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342

Appendix B.
In this clip, the speaker uses a pointing gesture to indicate that the
table she is referring to is the one in front of her
Script for gesture instruction presentation [video clip is repeated]
These pointing gestures can be used to identify objects and entities
The narrators speech is indicated in italics, with descriptions of the in our environment as well as indicating where things are located
accompanying video clips in [bold text inside square brackets]. Slide 3: Example gesture 2
Slide 1: Hand gestures are the spontaneous movements that we [video clip in which the speaker moves hand in a large
make with our hands and arms while speaking. These gestures can circular motion while saying its a really big table]
convey visual information about the objects and events that we are In this clip, the speaker uses a gesture in which she makes a large
talking about, for example by depicting the size and shape of an object circular motion to depict the table as large and round. This gesture
or the way in which an action is carried out. Some of these gestures adds information that is not contained in the accompanying speech as
convey information that is not contained in the accompanying speech the speech only refers to the size of the table, not its shape
and therefore can add to our understanding of the overall message. [video clip is repeated]
You will now see some examples of gestures that contain information. Slide 4: In the main experiment, you will view a series of video
Slide 2: Example gesture 1 clips of people describing pain and answer questions about the pain
[video clip in which the speaker points to the table in front of being described. You will notice that in these video clips people use
her while saying we have a table like this in our house] gestures alongside their speech and that these gestures often contain
information about the pain that they are describing. Before moving on
S.J. Rowbotham et al. / Patient Education and Counseling 99 (2016) 13331342 1341

to the main experiment, you are going to see some examples of the References
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